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Living longer in declining health: factors driving healthcare costs among older people

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dc.contributor.author Maynou Pujolràs, Laia
dc.contributor.author Street, Andrew
dc.contributor.author García-Altés, Anna
dc.date.accessioned 2023-11-27T11:28:15Z
dc.date.available 2023-11-27T11:28:15Z
dc.date.issued 2023
dc.identifier.citation Maynou L, Street A, García−Altés A. Living longer in declining health: factors driving healthcare costs among older people. Social Science & Medicine. 2023 Jun;327:115955. DOI: 10.1016/j.socscimed.2023.115955
dc.identifier.issn 0277-9536
dc.identifier.uri http://hdl.handle.net/10230/58378
dc.description Includes supplementary material for the online appendix.
dc.description.abstract Background. Developed countries are facing challenges in caring for people who are living longer but with a greater morbidity burden. Such people are likely to be regular users of healthcare. Objectives. Our analytical aim is to identify factors that explain healthcare costs among: (1) people over 55 years old; (2) the top 5% and 1% high-cost users among this population; (3) those that transition into the top 5% and 1% from one year to the next; (4) those that appear in the top 5% and 1% over multiple years; and (5) those that remain in the top 5% and 1% over consecutive years. Methods. The data covered 2011 to 2017 and comprised 1,485,170 observations for a random sample of 224,249 people aged over 55 years in the Catalan region of Spain. We analysed each person's annual healthcare costs across all public healthcare settings related to their age, gender, socio-economic status (SES), whether or not and when they died, and morbidity status, through Adjusted Morbidity Groups. Results. After controlling for morbidity status, the oldest people did not have the highest costs and were less likely to be among the most costly patients. There was also only a modest impact on costs associated with SES and with dying. Healthcare costs were substantially higher for those with a neoplasm or four or more long term conditions (LTCs), costs rising with the complexity of their conditions. These morbidity indicators were also the most important factors associated with being and remaining in the top 5% or top 1% of costs. Conclusion. Our results suggest that age and proximity to death are poor predictors of higher costs. Rather, healthcare costs are explained mainly by morbidity status, particularly whether someone has neoplasms or multiple LTCs. Morbidity measures should be included in future studies of healthcare costs.
dc.description.sponsorship LM is funded by the Spanish Ministry of Science, Innovation and Universities (PID2019104319RB-I00). AS received no funding for this project. AGA was employed at AQuAS when the project was underway.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartof Social Science & Medicine. 2023 Jun;327:115955
dc.rights © 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.title Living longer in declining health: factors driving healthcare costs among older people
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1016/j.socscimed.2023.115955
dc.subject.keyword Multimorbidity
dc.subject.keyword Long term conditions
dc.subject.keyword Adjusted morbidity groups
dc.subject.keyword Proximity to death
dc.relation.projectID info:eu-repo/grantAgreement/ES/2PE/PID2019104319RB-I00
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion


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